Citation Nr: 0913018
Decision Date: 04/08/09 Archive Date: 04/15/09
DOCKET NO. 06-13 230 ) DATE
)
)
On appeal from the
Department of Veterans Affairs Regional Office in Newark, New
Jersey
THE ISSUE
Entitlement to a rating in excess of 50 percent for post-
traumatic stress disorder (PTSD).
REPRESENTATION
Appellant represented by: Disabled American Veterans
ATTORNEY FOR THE BOARD
J. Murray, Associate Counsel
INTRODUCTION
The Veteran served on active duty in the United States Air
Force from October 1964 to September 1968.
This matter comes before the Board of Veterans' Appeals
(Board) on appeal from a January 2005 rating decision of the
Department of Veterans Affairs (VA) Regional Office in
Newark, New Jersey (RO), which, in pertinent part, denied the
claim sought on appeal.
FINDINGS OF FACT
The Veteran's disability due to PTSD causes no more than
occupational and social impairment, with reduced reliability
and productivity, or difficulty in establishing and
maintaining effective work relationships. The evidence does
not show occupational and social impairment, with
deficiencies in most areas such as work, family relations,
judgment, thinking, or mood, or shown an inability to
establish and maintain effective relationships.
CONCLUSION OF LAW
The schedular criteria have not been met for a disability
rating in excess of 50 percent for PTSD. 38 U.S.C.A. § 1155;
38 C.F.R. § 4.130, Diagnostic Code 9411 (2008).
REASONS AND BASES FOR FINDINGS AND CONCLUSION
1. Duty to Notify and Assist
As provided for by the Veterans Claims Assistance Act of 2000
(VCAA), VA has a duty to notify and assist claimants in
substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100,
5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2007);
38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2008).
When the VA receives a complete or substantially complete
application for benefits, the VCAA requires the VA to notify
the claimant of the information and evidence not of record
that is necessary to substantiate the claim. VA will inform
the Veteran, which information and evidence VA will seek to
provide, and which information and evidence the claimant is
expected to provide. 38 C.F.R. § 3.159(b). VA must also
provide the Veteran with notice that a disability rating and
an effective date will be assigned if service connection is
awarded. Dingess/Hartman v. Nicholson, 19 Vet. App. 473
(2006). VA must provide such notice to the claimant prior to
an initial unfavorable decision on a claim for VA benefits by
the agency of original jurisdiction (AOJ), even if the
adjudication occurred prior to the enactment of the VCAA.
See Pelegrini v. Principi, 18 Vet. App. 112, 119-120 (2004).
However, if VCAA notice is provided after the initial
decision, such a timing error can be cured by subsequent re-
adjudication of the claim, as in a Statement of the Case
(SOC) or Supplemental SOC (SSOC). Mayfield v. Nicholson, 20
Vet. App. 537, 543 (2006).
In the context of a claim for a increased rating, the VCAA
requires that
VA at least notify the Veteran that in order to substantiate
a claim, he must provide, or ask the Secretary to obtain,
medical or lay evidence demonstrating a worsening or increase
in severity of the disability and the effect that worsening
has on the claimant's employment and daily life. Vazquez-
Flores v. Peake, 22 Vet. App. 37 (2008). If applicable, the
Secretary must provide at least a general notice of any
additional requirements that would substantiate a higher
rating for the Veteran under the Diagnostic Code, which would
not otherwise be satisfied by the Veteran demonstrating a
noticeable worsening or increase in severity of the
disability and the effect that worsening has on the Veteran's
employment and daily life (such as a specific measurement or
test result). Further, the Veteran must be notified that a
disability rating will be determined by applying relevant
Diagnostic Codes, which typically provides for a range in
severity of a particular disability from noncompensable to as
much as 100 percent (depending on the disability involved)
based on the nature of the symptoms of the condition for
which disability compensation is being sought, their severity
and duration, and their impact upon employment and daily
life. The notice must also provide examples of the types of
medical and lay evidence that the Veteran may submit (or ask
the Secretary to obtain) that are relevant to establishing
entitlement to increased compensation. Such examples of
evidence would include competent lay statements describing
symptoms, medical and hospitalization records, medical
statements, employer statements, job application rejections,
and any other evidence showing an increase in the disability
or exceptional circumstances relating to the disability.
Vazquez-Flores, 22 Vet. App. at 43.
The U.S. Court of Appeals for the Federal Circuit (Court of
Appeals) has held that any error in a VCAA notice should be
presumed prejudicial. The claimant bears the burden of
demonstrating such error. VA then bears the burden of
rebutting the presumption, by showing that the essential
fairness of the adjudication has not been affected because,
for example, actual knowledge by the claimant cured the
notice defect, a reasonable person would have understood what
was needed, or the benefits sought cannot be granted as a
matter of law. Sanders v. Nicholson, No. 06-7001 (Fed. Cir.
May 16, 2007).
In October 2004, the RO sent the Veteran a letter informing
him of the types of evidence needed to substantiate his claim
and its duty to assist him in substantiating his claim under
the VCAA. The October 2004 letter informed the Veteran that
VA would assist him in obtaining evidence necessary to
support his claim. The Veteran was advised that it was his
responsibility to send medical records related to treatment
for his disability, or to provide a properly executed release
so that VA could request the records for him. In addition,
the Veteran has been specifically notified by the March 2006
Dingess notification letter that evidence demonstrating the
effect his disabilities have had on his employment would aid
in substantiating his claim.
While the Veteran has not been notified that evidence
demonstrating the effect of his disability on his daily life
would aid in substantiating his claim, the Board does not
find any procedural defect constitutes prejudicial error in
this case. See Sanders, 487 F.3d at 888-9. The Board finds
that the lack of notice regarding the effect of the Veteran's
disability on his daily life does not constitute prejudicial
error in this case because of evidence of actual knowledge on
the part of the Veteran and other documentation in the claims
file reflecting such notification that a reasonable person
could be expected to understand what was needed to
substantiate the claim(s). Id. The Court in Vazquez-Flores
held that actual knowledge is established by statements or
actions by the claimant or the claimant's representative that
demonstrate an awareness of what was necessary to
substantiate his or her claim. Vazquez-Flores, 22 Vet. App.
37 at 48, citing Dalton v. Nicholson, 21 Vet. App. 23, 30-31
(2007).
The Veteran's representative has demonstrated actual
knowledge of the need for evidence of the impact of the
Veteran's disabilities on daily life, specifically by stating
in the July 2005 Notice of Disagreement (NOD) that the
Veteran's disability has impacted him socially and
occupationally, and by providing supporting statements from
the Veteran's supervisor and VA psychiatrist. As the Veteran
and his representative have manifested actual knowledge of
the relevance of evidence showing the effect of the Veteran's
disability on his daily life, there was no prejudice from the
absence of complete notice on the first and third elements of
Vazquez-Flores notice.
The Board, therefore, finds that the purpose behind the
notice requirement has been satisfied because the Veteran has
been afforded a meaningful opportunity to participate
effectively in the processing of his claim. In addition, it
appears that all obtainable evidence identified by the
Veteran relative to his claim has been obtained and
associated with the claims file, and that neither he nor his
representative has identified any other pertinent evidence,
not already of record, which would need to be obtained for a
fair disposition of this appeal. It is the Board's
conclusion that the Veteran has been provided with every
opportunity to submit evidence and argument in support of his
claims, and to respond to VA notices.
Moreover, the Veteran has not demonstrated any error in VCAA
notice, and therefore the presumption of prejudicial error as
to such notice does not arise in this case. See Sanders,
supra.
Accordingly, VA has satisfied its duty to assist the Veteran
in apprising him as to the evidence needed, and in obtaining
evidence pertinent to his claim under the VCAA. Therefore,
no useful purpose would be served in remanding this matter
for yet more development. Such a remand would result in
unnecessarily imposing additional burdens on VA, with no
additional benefit flowing to the Veteran. The Court has
held that such remands are to be avoided. Sabonis v. Brown,
6 Vet. App. 426, 430 (1994).
In addition to its duty to notify, or inform, the Veteran
with regard to his claim, VA also has a duty to assist the
Veteran in the development of the claim. This duty includes
assisting the Veteran in the procurement of service treatment
records and records of pertinent medical treatment since
service, and providing the Veteran a medical examination when
necessary. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159.
As to the duty to assist, VA has associated with the claims
folder the Veteran's private and VA treatment records. The
Veteran was afforded formal VA examinations in November 2004
and February 2007. The Board notes that in the July 2005
NOD, the Veteran's representative referred to a
correspondence from the Veteran's supervisor, Richard J.
Clark, Associate Chief of Network 3 Prosthetics. The
representative stated that the correspondence was attached to
the NOD; however, the correspondence is not contained within
the Veteran's claims file. The Board notes that in the NOD
the Veteran's representative provided a summary of the
correspondence, which is sufficient to convey the meaning of
the correspondence for the purposes of this appeal.
In closing, the Veteran has not identified, and the record
does not otherwise indicate, any additional existing evidence
that is necessary for a fair adjudication of the claim that
has not been obtained. The Board finds that no additional
assistance is required to fulfill the VA's duty to assist.
Smith v. Gober, 14 Vet. App. 227 (2000), aff'd 281 F.3d 1384
(Fed. Cir. 2002).
2. Increased Rating for PTSD
Legal Criteria
Disability evaluations are determined by the application of
the facts presented to a schedule of ratings that is based on
the average impairment of earning capacity caused by a given
disability. Separate diagnostic codes identify the various
disabilities. 38 U.S.C.A. § 1155; 38 C.F.R. § 4.1. When
evaluating the severity of a disability, VA will consider the
entire history of the disability including records of social
impairment. See 38 C.F.R. § 4.126(a); Peyton v. Derwinski, 1
Vet. App. 282 (1991).
In cases involving a claim for an increased rating, VA's
primary focus is upon the current level of the Veteran's
disability. This will include a review of medical and lay
evidence of recording beginning one year prior to the time
Veteran requested an increase rating. That being said, VA
will also review the history of the Veteran's disability in
order to ensure that the decision regarding the current
disability rating accounts for all the prior treatment and
the severity of the disorder. Francisco v. Brown, 7 Vet.
App. 55, 58 (1994). The analysis in the following decision
is undertaken with consideration of the possibility that
different ratings may be warranted for different time
periods. See id.; Hart v. Mansfield, 21 Vet. App. 505
(2007). This practice is known as "staged" ratings.
The Veteran's disability has been rated as 50 percent under a
general set of criteria applicable to psychiatric
disabilities found at 38 C.F.R. § 4.130, Diagnostic Code
9411. Under the criteria found at Diagnostic Code 9411, a 50
percent rating is warranted when psychiatric disability
causes occupational and social impairment with reduced
reliability and productivity due to such symptoms as:
flattened affect; circumstantial, circumlocutory, or
stereotyped speech; panic attacks more than once a week;
difficulty in understanding complex commands; impairment of
short- and long-term memory; impaired judgment; impaired
abstract thinking; disturbances of motivation and mood; and
difficulty in establishing and maintaining effective work and
social relationships. 38 C.F.R. § 4.130.
A higher disability rating of 70 percent is warranted for
occupational and social impairment, with deficiencies in most
areas, such as work, school, family relations, judgment,
thinking, or mood, and inability to establish and maintain
effective relationships. Disability at this rating is due to
such symptoms as: suicidal ideation; obsessive rituals which
interfere with routine activities; speech intermittently
illogical, obscure, or irrelevant; near-continuous panic or
depression affecting the ability to function independently,
appropriately and effectively; impaired impulse control;
spatial disorientation; neglect of personal appearance and
hygiene; difficulty in adapting to stressful circumstances.
38 C.F.R. § 4.130.
A higher, 100 percent rating, is warranted for more severe
symptoms. 38 C.F.R. § 4.130.
It is not expected that all cases will show all the findings
specified; however, in all instances it is expected that
there will be sufficient findings as to identify the disease
and the disability there from, and to coordinate the rating
with the identified impairment of function. 38 C.F.R. §
4.21. Where there is a question as to which of two rating
evaluations shall be applied, the higher evaluation will be
assigned if the disability picture more nearly approximates
the criteria required for that rating. Otherwise, the lower
rating will be assigned. 38 C.F.R. § 4.7.
In rating the severity of the Veteran's service-connected
psychiatric disability under the criteria listed above, the
Board is aware of the fact that psychiatric health care
providers have their own system for rating psychiatric
disability. This is the Global Assessment of Functioning
(GAF) rating scale, and it is a scale reflecting the
psychological, social, and occupational functioning on a
hypothetical continuum of mental-health illness. See
Diagnostic and Statistical Manual for Mental Disorders,
Fourth Edition, of the American Psychiatric Association (DSM-
IV); Richard v. Brown, 9 Vet. App. 266, 267 (1996)(citing
DSM-IV). The GAF scale score assigned does not determine the
disability rating VA assigns, however, it is one of the
medical findings that may be employed in that determination,
and it is highly probative, as it relates directly to the
Veteran's level of impairment of social and industrial
adaptability. VAOPGCPREC 10-95; See Massey v. Brown, 7 Vet.
App. 204, 207 (1994).
Regarding the GAF scale score relevant to the case at hand
the following applies. GAF score from 51 to 60 represents
moderate symptoms, or moderate difficulty in social or
occupational functioning. A GAF scale score from 41 to 50 is
indicative of serious symptoms or a serious impairment in
social, occupational, or school functioning. See Quick
Reference to the Diagnostic Criteria from DSM-IV, 46-47
(1994).
When all the evidence is assembled, VA is responsible for
determining whether the evidence supports the claim or is in
relative equipoise, with the Veteran prevailing in either
event, or whether a preponderance of the evidence is against
a claim, in which case, the claim is denied. Gilbert v.
Derwinski, 1 Vet. App. 49, 55 (1990). Any reasonable doubt
will be resolved in favor of granting the Veteran's claim.
38 U.S.C.A. § 5107 (West 2002); Ortiz v. Principi, 274 F.3d
1361, 1364 (Fed. Cir. 2001); 38 C.F.R. § 3.102 (2008).
Factual Background
In September 2004, the Veteran filed a claim for an increased
rating for his service-connected PTSD. Early in September
2004, the Veteran underwent an Initial Psychiatric Assessment
at the VA Medical Center at East Orange (VAMC). In that
assessment report, the examiner confirmed a diagnosis of PTSD
due to past combat experiences with a GAF scale score of 41.
The examiner noted that the Veteran complained that he had
difficulty sleeping, and that he would have nightmares and
wake from his sleep with cold sweats and tachycardia. The
Veteran reported that he drank a pint of alcohol each night
to help him sleep. He also reported that he isolated himself
from others and had problems maintaining personal
relationships.
At the time of the September 2004 assessment, the Veteran
reported that he had been employed for over 25 years in the
prosthetics department at the VAMC. He stated that he had
"problems with authority figures and co workers until he was
assigned to the Prosthetic Department because all the works
are Vietnam Veterans and they all understand each other."
With respect to his marital status, the Veteran reported that
he had been married twice and divorced twice. He reported
that his first marriage ended because his wife had been
afraid of him as result of his drinking problems.
In November 2004, the Veteran was afforded a VA psychiatric
examination to evaluate the severity of his mental disorder.
The examiner noted that the Veteran had not been hospitalized
for his psychiatric disorder, and that he had been treated
with medication and psychotherapy at the VAMC. The Veteran
reported nightmares, flashbacks, hyper-vigilance, depression,
irritability, and poor concentration. At the time of the
examination, the Veteran was still employed in the
prosthetics unit at the VAMC. He reported that he was
"having problems with his coworkers because of his anger."
The Veteran reported that he isolated himself from others,
and that he had few social contacts. With regard to his
marital status, the Veteran reported that his relationship
with his second wife was "strained".
On the mental status examination, the October 2004 examiner
noted that the Veteran was cooperative but his mood was
irritable. His speech, thought processes and thought content
were normal. The Veteran was orient to person, place and
time, and his insight, judgment and impulse control were
fair. At the time of the examination, the Veteran did not
have any suicidal or homicidal ideations. The examiner
confirmed that the Veteran had PTSD with a GAF scale score of
45. Although, the examiner concluded that the Veteran had
problems at work and isolated himself from others, the
examiner found that the Veteran was still employed and
married despite his PTSD symptoms.
The Veteran continued to receive treatment from the VAMC for
his PTSD. In a January 2005 progress note, VA psychiatrist
recorded that the Veteran had been taking his medication with
some results, however, he still complained of difficulty with
sleeping and nightmares. In a March 2005 progress note, the
Veteran reported increase anxiety due to his current
separation from his second wife. In a July 2005 progress
note, VA psychiatrist noted that the Veteran reported more
anxiety and stress because of a disruption in his medication.
The examiner reinstated the Veteran's medication program.
In the July 2005 Notice of Disagreement, the Veteran's
representative stated that the Veteran's condition had
worsened. In support of claim, he provided a summary of a
correspondence from the Veteran's supervisor, and a July 2005
letter from the Veteran's attending VA psychiatrist, Dr. J.
Falcon. In the summary, the representative recorded that the
Veteran's Supervisor had reported that the Veteran's work
habits had deteriorated over the past two years, and the
Veteran had become unreliable because of his loss of
concentration and irritability with co-workers.
In his July 2005 letter, Dr. Falcon reported that the
Veteran's PTSD symptoms have worsened since the World Trade
Center Tragedy. Specifically, he noted that the Veteran's
employment situation and marriage have deteriorated
significantly because of his PTSD symptoms. Dr. Falcon
concluded by stating that the Veteran's abilities to
gainfully retain his actual job have decreased and that he is
on the verge of losing it due the intense increase of his
symptoms.
The Veteran's claims file contained the following pertinent
treatment records from VAMC which will be discussed further
in the February 2007 VA examination report below: an
Emergency Room Triage Note in August 2006; a Preventive
Health Depression Screening report in July 2006; a Non-urgent
Triage Initial Note in December 2006; and a PTSD Screening
examination report in January 2007.
In February 2007, the Veteran underwent another VA
psychiatric examination to determine the severity of his PTSD
symptoms. The examiner noted that the Veteran complained
that his depression had worsened since the start of the Iraq
War in 2002. He admitted alcohol abuse, and that he drinks
at least one pint of alcohol a day. He reported he was
currently separated from his second wife, and that she had
left him because his verbal and physical abuse. He reported
that he had two children, and that his relationship with them
was "beautiful". He further reported that he had
"supportive" friends and family. As for his occupational
status, the Veteran reported that his was still employed in
the prosthetics unit at VAMC. He stated that "as a rule, I
go in, do my work and I don't socialize." The Veteran
reported "had been written up a few times", but he would
not provide any details for these occurrences.
On mental status examination, the February 2007 examiner
noted that the Veteran was tense, irritable and angry. He
found that the Veteran's judgment and insight were limited.
The examiner noted that, although the Veteran reported he
felt depressed, he did not present as depressed. He reported
that the Veteran admitted both suicidal and homicidal
ideation. The Veteran stated that he often felt suicidal as
his marriage "soured" and that he had thought of killing
his wife before she had actually left him. The examiner
noted that the Veteran reported auditory hallucinations.
In the February 2007 examination report, the examiner noted
that he had reviewed the Veteran's claims file, and found
that the Veteran's responses during the February 2007
examination were inconsistent from his responses in previous
medical treatment sessions. The examiner explained:
The Veteran reported being depressed since the war
stared in 2002, but denied being depressed when
screened for this on 7/17/06. This Veteran
reported homicidal and suicidal ideations since he
was married in 1998, and reported auditory
hallucinations for the past year, but denied all of
this according to his 8/16/06 entry. This Veteran
reported poor concentration and memory of 1 year's
duration, but recently denied this according to his
12/7/06 entry. In addition, this Veteran reported
being increasingly reminded of Vietnam, but accord
to his 1/17/07 PTSD screening, he reported "no"
when asked if he had recently experienced any
frightening, horrible or upsetting episodes of
nightmares, intrusive thoughts, attempts to avoid
these troubling experience, being on guard or
watchful or easily startled or feeling numb or
detached from others.
February 2007 VA examination report.
The February 2007examiner diagnosed the Veteran with alcohol
abuse, rather than with PTSD because "there is no clear and
convincing evidence that this Veteran meets the DSM-IV
criteria for [that] second diagnosis." The examiner noted
that with respect to the Veteran's previous PTSD diagnosis,
the Veteran was inconsistent in reporting his combat-related
traumatic stress symptoms. In addition, the Veteran did not
report persistent symptoms associated with a combat-related
traumatic event, such as, increased arousal, numbing,
intrusive thoughts, flashbacks and nightmares during the
February 2007 examination. As to the Veteran's current
symptomatolgy, the examiner concluded that "it was
impossible to determine the extent to which this Veteran's
alcohol abuse impacts his social or occupational functioning,
due to his providing inconsistent information from different
interviews." The examiner had noted that based on a review
of those records, it showed that the Veteran had some
improvement in his social functioning and in his PTSD
symptoms. The examiner gave the Veteran a GAF scaled score
of 55.
Analysis
As an initial matter, the Board notes that although the
examiner who performed the February 2007 examination
indicated that the Veteran did not appear to have a current
diagnosis of PTSD pursuant to 38 C.F.R. § 4.125(a)
(conforming to the Diagnostic and Statistical Manual of
Mental Disorders, Fourth Edition (DSM-IV), service connection
has already been awarded for disability due to PTSD. The
Board confines its decision to the issue now on appeal,
whether disability due to the Veteran's service-connected
psychiatric disorder warrants a rating in excess of 50
percent.
After review of the evidence on file from throughout the
appeal period, the Board finds that the objective medical
findings clearly do not support an assignment in excess of 50
percent. For such an increase to the next higher 70 percent
level, the evidence would have to show that the Veteran's
service-connected psychiatric disability causes occupational
and social impairment, with deficiencies in most areas, such
as work, school, family relations, judgment, thinking, or
mood, and inability to establish and maintain effective
relationships. Additionally, there would have to be
objective medical evidence showing: obsessive rituals which
interfere with routine activities; speech intermittently
illogical, obscure, or irrelevant; near-continuous panic or
depression affecting the ability to function independently,
appropriately and effectively; spatial disorientation;
neglect of personal appearance and hygiene. 38 C.F.R. §
4.130. These findings are not evident in the record.
The February 2007 examiner did not find that the Veteran was
depressed at the time of the examination, and the Veteran did
not indicate that he suffered from depression during January
2007 PTSD Screening. The Veteran's judgment and insight were
found to be limited by the February 2007 examiner; however,
as later noted by that examiner, it was difficult for him
ascertain whether these impairments were only associated with
the Veteran's alcohol abuse.
The Board notes that during the February 2007 examination,
the Veteran admitted to suicidal and homicidal ideations, but
as observed by the February 2007 examiner, these responses
were inconsistent from previous ones in August 2006. The
February 2007 examiner noted that although the Veteran
reported homicidal and suicidal ideations since the start of
his second marriage in 1998, he denied these symptoms in the
August 2006 treatment record. This inconsistency goes
towards the credibility of the Veteran in providing an
account of his symptomatology.
The Boards notes that the Veteran's disability has affected
his employment and his relationships with others. The
Veteran's supervisor stated that the Veteran's employment has
deteriorated, and that he was unreliable because he lost
concentration and did not get along well with his co-workers.
The Veteran also reported some disciplinary actions against
him. Despite his difficulty at work, it is important to
point out that the Veteran has maintained his employment for
over 27 years, and that he is currently still employed by
VAMC. Although the Veteran reported marital problems with
both of his marriages, he had also reported that his
relationship with his children was "beautiful" and that he
had supportive family and friends. The February 2007
examiner even noted that the Veteran had some improvements in
his social functions compared to findings in the November
2004 VA examination.
In short, after a review of all the evidence of record, the
Board finds that the currently assigned 50 percent rating is
appropriate, and that disability due to the Veteran's
service-connected psychiatric problems does not warrant an
increased evaluation to the next higher rating (and does not
approximate those criteria). The Board has considered the
doctrine of reasonable doubt; however, as the preponderance
of the evidence is against the Veteran's claim, the doctrine
is not for application. 38 U.S.C.A. § 5107(b); Ortiz v.
Principi, 274 F.3d 1361, 1364 (Fed. Cir. 2001); Gilbert v.
Derwinski, 1 Vet. App. 49, 55-57 (1990).
As a final note, the Board does not find that "staged"
ratings are warranted at any point since during the appeal
period because the evidence does not show variable
symptomatology that is at any point more severe than that
warranting the current rating. 38 C.F.R. § 4.71a; See
Fenderson, 12 Vet. App. at 126. Should the Veteran's
disability picture change in the future, he may be assigned a
higher rating. See 38 C.F.R. § 4.1.
ORDER
Entitlement to increase rating in excess of 50 percent for
PTSD is denied.
____________________________________________
DENNIS F. CHIAPPETTA
Veterans Law Judge, Board of Veterans' Appeals
Department of Veterans Affairs